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drugs y3 > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

How does penicillin work

A
  • has a beta-lactam ring which has anti-microbial activity
  • inhibits enzymes responsible for cross-linking peptidoglycans in bacterial cell walls
  • weakens strength of cell wall
  • preventing them from maintain their osmotic gradient
  • causes water to move into the cell and the cell to lyse and die
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2
Q

what type of penicillin is amoxacillin

A

broad spectrum

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3
Q

what type of penicillin is co-amoxiclac

A

broad spectrum

  • used in severe, resistant hospital acquired infections
  • contains amoxicillin
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4
Q

what type of penicillin is flucloxacillin

A

penicillinase resistant penicillins

- narrow spectrum

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5
Q

what type of penicillin is benzylpenicillin

A

narrow spectrum

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6
Q

when is penicillin used

A

all types of infections

  • skin and soft tissue
  • UTRI
  • pneumonia
  • endocarditis
  • tonsilitis
  • UTI
  • H.pylori associated with PUD
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7
Q

contraindications of penicillin

A
  • allergy (always find out what type of allergy - is it just a rash or is it anaphylaxis?
  • give in caution to patients with c.difficile infections or with severe renal impairment
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8
Q

side effects of penicillin

A
  • GI upset, nausea, diarrhoea
  • allergy (can range from rash to anaphylaxis)
  • more rare: antibiotic associated colitis, acute liver injury
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9
Q

possible interactions with penicillin

A
  • can enhance anti-coag effects of warfarin

- reduces renal excretion of methotrexate so can lead to toxicity

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10
Q

how do cephalosporins work

A
  • contain a beta lactam ring
  • inhibit enzymes which are responsible for making peptidoglycans for bacterial cell walls
  • weakens strength of cell
  • preventing them from maintaining their osmotic gradient
  • water enters cells and cells lyse and die
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11
Q

examples of cephalosporins

A

cefalexin

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12
Q

are cephalosporins broad spectrum or narrow spectrum antibiotics

A

broad spectrum

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13
Q

when are cephalosporins used?

A

2nd and 3rd line in UTIs and respiratory tract infections

meningitis as can cross BBB

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14
Q

contraindications of cephalosporins

A 
- allergy
caution with:
- severe renal failure
- epilepsy
- c.difficile infection
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15
Q

side effects of cephalosporins

A
  • GI disturbance, nausea, diarrhoea
  • allergy (rash to anaphylaxis)
    more rare
  • seizure
  • antibiotic-associated colitis
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16
Q

possible interactions of cephalosporins

A
  • enhance anti-coag effects of warfarin (as of killing of normal gut flora which synthesise vitamin K)
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17
Q

how does trimethoprim work

A
  • inhibits bacterial folate synthesis
  • prevents bacteria from utilising folate for functions such as DNA synthesis
  • slows down bacterial growth and replication
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18
Q

is trimethoprim broad or narrow spectrum

A

broad yet use is decreasing due to bacterial resistance

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19
Q

contraindications of trimethoprim

A 
- first trimester of pregnancy
caution in those with...
- folate deficiency
- HIV
- elderly
- neonates
- renal impairment
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20
Q

side effects of trimethoprim

A
  • GI disturbance (N+V)
  • sore mouth
  • skin rash
  • severe hypersensitivity reactions
  • hyperkalaemia
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21
Q

possible interactions with trimethoprim

A
  • drugs which cause potassium elevation (ACEi, ARB, spironolactone)
  • drugs which increase folate metabolism (phenytoin)
  • drugs which are folate antagonists (methotrexate)
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22
Q

how does nitrofurantoin work

A
  • metabolised by bacteria cells by nitrofuran reductase
  • metabolites of this drug damage bacteria DNA
  • cause bacterial cell death
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23
Q

when is nitrofurantoin used

A

1st line for UTI

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24
Q

what bacteria does nitrofurantoin target

A
  • gram -ve e.coli

- gram +Ve staph saptophyticus

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25
Q

contraindications for nitrofurantoin

A
  • last trimester of pregnancy
  • in first 3 months of life
  • CKD
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26
Q

side effects of nitrofurantoin

A
  • GI upset (diarrhoea and nausea)
  • hypersensitivity reactions
  • turns urine dark yellow, brown
  • less common: pneumonitis, hepatitis, peripheral neuropathy
27
Q

possible interactions for nitrofurantoin

A

n/a

28
Q

examples of tetracyclines

A

doxycycline, lymecycline

29
Q

when are tetracyclines used

A
  • acne
  • lower RTI such as pneumonia and infective exacerbations of COPD
  • chlamydial infections such as pelvic inflammatory disease
  • other infections such as Lyme disease, malaria, typhoid and anthrax
30
Q

contraindications of tetracyclines

A
  • children under 12 (causes tooth enamel hypoplasia and fluorescent yellow teeth)
  • pregnancy
  • breastfeeding
31
Q

side effects of tetracyclines

A
  • GI disturbance
  • hypersensitivity
  • oesophageal ulcers or dysphagia
  • photosensitivity
  • tooth enamel hyperplasia
32
Q

possible interactions of tetracyclines

A
  • do not give within 2hrs of calcium iron or antacids as they bind to these, thus decreasing their absorption and action
33
Q

examples of aminoglycosides

A

gentamicin

34
Q

how do aminoglycosides work

A

bind irreversibly to bacterial ribosomes, preventing protein synthesis

35
Q

what type of bacteria do aminoglycosides target

A
  • severe infections

- typically gram negative anaerobes

36
Q

when are aminoglycosides used?

A
  • severe sepsis of unknown cause
  • pyelonephritis or complicated UTI
  • biliary or other intra-abdominal sepsis
  • endocarditis
37
Q

side effects of aminoglycosides

A

nephrotoxicity - accumulate in renal tubular epithelial cellss
ototoxicity - accumulate in vestibular and cochlear cells

38
Q

possible interactions of aminoglycosides

A

ototoxicity is more likely if given with loop diuretics

39
Q

examples of macrolides

A

erythromycin, clarithromycin

40
Q

how do macrolides work

A

bind to the 50s ribosome, preventing bacterial protein synthesis - bacteriostatic

41
Q

when are macrolides used

A
  • skin, soft tissue and respiratory infections when penicillin is contraindicated
  • severe pneumonia in addition to penicillin
  • H.pylori in addition to penicillin and a PPI
42
Q

when are macrolides contraindicated

A

hypersensitivity

43
Q

side effects of macrolides

A
  • GI disturbance (N, V, D, abo pain) if PO
  • thrombophlebitis if IV
  • allergy
  • antibiotic-associated colitis
  • QT interval elongation, predisposing to arrythmias
  • cholestatic jaundice
44
Q

possible interactions of macrolides

A
  • other drugs which could cause arrythmias

- inhibit cytochome P540 enzymes, affecting drugs which are metabolised by these such as warfarin

45
Q

examples of quinolones

A

ciprofloxacin

46
Q

how do quinolones work

A

kill bacteria by inhibiting bacterial DNA synthesis

- bactericidal

47
Q

what type of bacteria do quinolones target

A

mainly gram negative aerobes

- increasingly resistant

48
Q

when are quinolones used

A
  • mainly kept to 2nd or 3rd line due to chance of resistance
  • UTI
  • severe GI infection
  • only oral antibiotic which acts against Pseudomonas aeruginosa
49
Q

when are quinolones contraindicated

A

caution if arrhythmias, in children or at risk of seizures

50
Q

side effects of quinolones

A
  • gi upset
  • hypersensitivity
  • increased risk of ruptured muscle tendons
  • increased risk of seizures and hallucinations
  • QT interval elongation
51
Q

possible interactions with quinolones

A
  • inhibit cytochrome p450 enzymes so increase risk of toxicity of drugs metabolised by these such as theophylline
  • caution with prednisolone due to risk of muscle tendon rupture
  • caution with NSAIDs due to increase risk of seizure
  • caution with drugs which may elongate QT interval
52
Q

examples of anaerobic antimicrobials

A

metronidazole

53
Q

how does metronidazole work

A
  • taken up by bacteria
  • in anaerobic bacteria and is reduced to form nitroso free radical
  • this binds to DNA, reducing DNA synthesis
  • bacterial cells die
  • aerobic bacteria does not reduce metronidazole
54
Q

when is metronidazole used

A
  • anti-biotic associated colitis by gram positive anaerobic C.difficile
  • gynae and surgical infections (bacteria from the gut)
  • oral infections and aspiration pneumonia
  • protozoal infections
55
Q

when is metronidazole contraindicated

A

alcohol

56
Q

side effects of metronidazole

A
  • GI upset
  • hypersensitivity
  • at high dose, peripheral and optic neuropathy, seizures, encephalopathy
57
Q

possible interactions of metronidazole

A
  • lithium toxicity
  • inhibits cytochrome P450 inhibitors
  • enhance cytochrome P450 inducers
58
Q

examples of glycopeptides

A

vancomycin

59
Q

what does vancomycin target

A

mainly gram positive bacteria

- gram negative bacteria have slightly different cell wall structures

60
Q

how does vancomycin work

A

inhibits cross linking and enzymes in peptidoglycan bacterial cell wall synthesis

  • weakens structure of cell
  • water enters, cell lyses and dies
  • bacteriostatic
61
Q

when is vancomycin contraindicated

A

caution in elderly or renal impairment

62
Q

side effects of vancomycin

A
  • thrombophlebitis at infusion site
  • ‘red man syndrome’ (generalised erythema)
  • IV rarer: nephrotoxicity, ototoxicity, neutropenia, thrombocytopenia
63
Q

when is vancomycin used

A
  • 2nd line in antibiotic associated colitis

- gram positive infections if severe or penicillin contraindicated - such as endocarditis

64
Q

possible interactions with vancomycin

A

drugs which can also induce nephrotoxicity or ototoxicity

drugs y3 (10 decks)

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